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General NPI Number Information
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NPI Number | 1386846913
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Entity Type | Organization
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Legal Business Name | RON G DAVIDSON, OD PC DBA EYES NOUVEAU
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 3000 S HULEN ST SUITE 104
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City | FORT WORTH
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State | TX
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Zip | 76109-1929
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Country | US
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Telephone | 817-738-2027
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Fax | 817-738-5440
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Provider Business Mailing Address
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Address Line | 3000 S HULEN ST SUITE 104
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City | FORT WORTH
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State | TX
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Zip | 76109-1929
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Country | US
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Telephone | 817-738-2027
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Fax | 817-738-5440
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DOROTHY C ANGUS
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Credential |
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Telephone | 817-738-2027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2361TG
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License Number State | TN
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